Multimorbidity and mortality in an older, rural Black South African population cohort with high prevalence of HIV-findings from the HAALSI study

Research output: Contribution to journalArticlepeer-review


  • Alisha N Wade
  • Collin F Payne
  • Lisa F Berkman
  • Angela Y Chang
  • F Xavier Gómez-Olivé
  • Chodziwadziwa W Kabudula
  • Kathleen Kahn
  • Joshua A Salomon
  • Stephen M Tollman
  • Miles D Witham

Colleges, School and Institutes


Objectives: Multimorbidity is associated with mortality in high-income countries. Our objective was to investigate the relationship between multimorbidity (≥2 of the following chronic medical conditions: hypertension, diabetes, dyslipidaemia, anaemia, HIV, angina, depression, post-traumatic stress disorder, alcohol dependence) and all-cause mortality in an older, rural Black South African population. We further investigated the relationship between HIV multimorbidity (HIV as part of the multimorbidity cluster) and mortality, while testing for the effect of frailty in all models.

Design: Population cohort study.

Setting: Agincourt sub-district of Mpumalanga province, South Africa.

Participants: 4455 individuals (54.7% female), aged ≥40 years (median age 61 years, interquartile range 52-71) and resident in the study area.

Primary and secondary outcome measures: The primary outcome measure was time to death and the secondary outcome measure was likelihood of death within two years of the initial study visit. Mortality was determined during annual population surveillance updates.

Results: 3157 individuals (70.9%) had multimorbidity; 29% of these had HIV. In models adjusted for age and sociodemographic factors, multimorbidity was associated with greater risk of death (women: HR 1.72; 95%CI:1.18-2.50; men: HR 1.46; 95%CI:1.09-1.95) and greater odds of dying within two years (women: OR 2.34; 95%CI:1.32-4.16; men: OR 1.51; 95%CI:1.02-2.24). HIV multimorbidity was associated with increased risk of death compared with non-HIV multimorbidity in men (HR 1.93; 95%CI:1.05-3.54), but was not statistically significant in women (HR 1.85; 95%CI:0.85-4.04); when detectable, HIV viral loads were higher in men (p=0.021). Further adjustment for frailty slightly attenuated the associations between multimorbidity and mortality risk (women: HR 1.55; 95%CI:1.06-2.26; men: HR 1.36; 95%CI:1.01-1.82), but slightly increased associations between HIV multimorbidity and mortality risk.

Conclusions: Multimorbidity is associated with mortality in this older Black South African population. Health systems which currently focus on HIV should be reorganised to optimise identification and management of other prevalent chronic diseases.


Original languageEnglish
Article numbere047777
Number of pages9
Issue number9
Publication statusPublished - 15 Sep 2021


  • multimorbidity, South Africa, population health, chronic disease, mortality

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